title: Derivation and validation of a renal risk score for people with type 2 diabetes.
abstract: OBJECTIVE
  Diabetes has become the leading cause of end-stage renal disease (ESRD). Renal risk stratification could assist in earlier identification and targeted prevention. This study aimed to derive risk models to predict ESRD events in type 2 diabetes in primary care.
  
  
  METHODS
  The nationwide derivation cohort included adults with type 2 diabetes from the New Zealand Diabetes Cohort Study initially assessed during 2000-2006 and followed until December 2010, excluding those with pre-existing ESRD. The outcome was fatal or nonfatal ESRD event (peritoneal dialysis or hemodialysis for ESRD, renal transplantation, or death from ESRD). Risk models were developed using Cox proportional hazards models, and their performance was assessed in a separate validation cohort.
  
  
  RESULTS
  The derivation cohort included 25,736 individuals followed for up to 11 years (180,497 person-years; 86% followed for ≥5 years). At baseline, mean age was 62 years, median diabetes duration 5 years, and median HbA1c 7.2% (55 mmol/mol); 37% had albuminuria; and median estimated glomerular filtration rate (eGFR) was 77 mL/min/1.73 m2. There were 637 ESRD events (2.5%) during follow-up. Models that included sex, ethnicity, age, diabetes duration, albuminuria, serum creatinine, systolic blood pressure, HbA1c, smoking status, and previous cardiovascular disease status performed well with good discrimination and calibration in the derivation cohort and the validation cohort (n=5,877) (C-statistics 0.89-0.92), improving predictive performance compared with previous models.
  
  
  CONCLUSIONS
  These 5-year renal risk models performed very well in two large primary care populations with type 2 diabetes. More accurate risk stratification could facilitate earlier intervention than using eGFR and/or albuminuria alone.
authors.affiliation: Corresponding author: C. Raina Elley, c.elley@auckland.ac.nz.
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
authors.forename: Tom
authors.initials: T
authors.lastname: Robinson
authors.forename: Simon A
authors.initials: SA
authors.lastname: Moyes
authors.forename: Tim
authors.initials: T
authors.lastname: Kenealy
authors.forename: John
authors.initials: J
authors.lastname: Collins
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.forename: Brandon
authors.initials: B
authors.lastname: Orr-Walker
authors.forename: Paul L
authors.initials: PL
authors.lastname: Drury
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin